| NPI | 1396489936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX 1107084) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: TX 829530) |
| Enumeration Date | 2022-04-20 |
| Last Update Date | 2023-01-12 |